Task force: Men over age 75 should not be screened for PCa

Men age 75 years and older should not be screened for prostate cancer, and younger men should discuss the benefits and harms of the PSA test with their clinicians before being tested, according to a new recommendation from the U.S. Preventive Services Task Force published in the Annals of Internal Medicine (2008; 149:185-91).

The task force found evidence that screening for prostate cancer provided few health benefits, but led to substantial physical and some psychological harms in men age 75 and older. In men younger than 75 with chronic medical problems and a life expectancy of fewer than 10 years, the task force concluded that current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening.

“Because many prostate cancers grow slowly, early detection may not benefit a patient’s health, and in some cases, may even cause harm,” said task force chair Ned Calonge, MD, MPH, of the Colorado Department of Public Health and Environment, Denver. “We encourage men younger than 75 to discuss with their clinicians the potential-but uncertain-benefits and the possible harms of getting the PSA test before they decide to be screened.”

Current data show that one-third of all men in the United States over age 75 receive PSA testing. Although most major medical organizations suggest that prostate cancer screening may be discontinued in men with a life expectancy of fewer than 10 years, the task force is the first group to define an explicit age cutoff above which screening is likely to be ineffective or harmful. The results of two ongoing clinical trials-the National Cancer Institute’s Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and the European Study of Screening for Prostate Cancer-should clarify the potential benefits of screening in men under the age of 75.